Revlimid in Transfusion Dependent Patients

Inclusion Criteria: * Understand and voluntarily sign an informed consent form. * Age ≥ 21 years at the time of signing the informed consent form. * Able to adhere to the study visit schedule and other protocol requirements. * A confirmed diagnosis (using standard FAB criteria) of a myelodysplastic syndrome with low/Int-1 risk and with a non-del(5q) karyotype must be established. * Patients must have transfusion dependence (at least 2 units within 8 weeks prior to starting therapy). * All transfusion dependent non-del(5q) low/Int-1 risk patients will be eligible for treatment with Revlimid® * Newly diagnosed as well as previously treated patients will be eligible * Patients with primary de novo or secondary MDS will be eligible * All previous cancer therapy, including radiation, hormonal therapy and surgery, must have been discontinued at least 4 weeks prior to treatment in this study. * ECOG performance status of 0-2 at study entry (see Appendix II). * Laboratory test results within these ranges: * Absolute neutrophil count \> 250/uL * Platelet count \> 30,000/uL * Serum creatinine ≤ 2.0 mg/dL * Total bilirubin ≤ 1.5 mg/dL * AST (SGOT) and ALT (SGPT) ≤ 3 x ULN * BUN ≤ 2 x ULN * Disease free of prior malignancies for ≥ 2 years with exception of currently treated basal cell, squamous cell carcinoma of the skin, or carcinoma "in situ" of the cervix or breast. * All study participants must be registered into the mandatory RevAssist® program, and be willing and able to comply with the requirements of RevAssist®. * Females of childbearing potential (FCBP)† must have a negative serum or urine pregnancy test with a sensitivity of at least 50 mIU/mL within 10 - 14 days prior to and again within 24 hours of prescribing lenalidomide (prescriptions must be filled within 7 days) and must either commit to continued abstinence from heterosexual intercourse or begin TWO acceptable methods of birth control, one highly effective method and one additional effective method AT THE SAME TIME, at least 28 days before she starts taking lenalidomide. FCBP must also agree to ongoing pregnancy testing. Men must agree to use a latex condom during sexual contact with a FCBP even if they have had a successful vasectomy. Exclusion Criteria: * Any serious medical condition, laboratory abnormality, or psychiatric illness that would prevent the subject from signing the informed consent form. * Pregnant or breast feeding females. (Lactating females must agree not to breast feed while taking lenalidomide). * Any condition, including the presence of laboratory abnormalities, which places the subject at unacceptable risk if he/she were to participate in the study or confounds the ability to interpret data from the study. * Any clinically significant cardiac disease, including congestive heart failure * Liver function studies including SGOT/SGPT \> 3 x ULN * Clinically significant renal disease. * Any previous chemotherapy, hematopoietic growth factors, erythropoietin, or cytokines within 4 weeks of starting treatment. Note: prior therapy with G-CSF within 4 weeks is allowed. * Use of any other experimental drug or therapy within 28 days of baseline. * Known hypersensitivity to thalidomide. * The development of erythema nodosum if characterized by a desquamating rash while taking thalidomide or similar drugs. * Any prior use of lenalidomide. (Patients with prior therapy with thalidomide will be eligible as long as at least 4 weeks have elapsed between end of the drug and accrual on the present trial) * Concurrent use of other anti-cancer agents or treatments. * Known positive for HIV or infectious hepatitis, type B or C. * Life expectancy \< 3 months